There are two ways you can have your baby: a vaginal birth or surgical delivery by cesarean section (C-section). The ultimate goal of both methods is to ensure a successful delivery, in which both you and your baby are healthy and safe. It’s an important decision and should be made in consultation with your healthcare provider, taking into consideration your health, your health history, and what is best for both you and your child.

Delivery in South Africa

The World Health Organisation has stated that “C-section rates should range between 10% and 15%.”  In South Africa, however, C-section rates are much higher in both public and private sector hospitals. This reflects a global trend, where worldwide, C-section rates have been steadily increasing, despite the fact that this does not provide any extra benefit to the health of either mother or child.

A SAMJ (South African Medical Journal) article published in 2020 reported C-section birth rates in South Africa:

• Public hospitals: 27.4%
• Private sector: 73%

Globally the average is 21%.

There are a number of reasons for South Africa’s high rates. The main one is that C-section delivery is often perceived as the safer way to give birth. Unfortunately, the SAMJ article also reported that women who have C-sections in public hospitals in South Africa are three times more likely to die than those who undergo vaginal delivery. While some of these deaths were related to pre-eclampsia and eclampsia (six times increased risk of death), most occurred due to loss of blood either during or after the procedure.

Other reasons include choosing a delivery date that is convenient for both the mother and doctor, as well as fear of potential medical malpractice suits if the outcomes of vaginal delivery are not as expected. It is essential that you understand your right to choose a birth plan independent of what your healthcare provider may find more convenient, balanced with your understanding of the risks inherent in each method based on your unique medical status. 

Disapproval has no place in the delivery room

The Bonitas Female Health Care Programme was created to provide a safe place for women to access the healthcare information they require in order to make the best possible decisions for them and their families. This includes decisions around your birth plan. Unfortunately, what is a personal decision is often subject to very public debate and opinions.

Women who have C-sections are often accused of choosing the “easy” option or being “too posh to push.” This is problematic on many levels, not least the fact that not all women get a choice. Sometimes, having a C-section is a medical necessity.  Women are judged for not having a “natural birth” if they use any form of pain relief or medical assistance. When in reality we should be celebrating all successful births, and not belittling women for how they give birth!  The choice of how you give birth does not reflect your abilities as a mother.

Making your decision

There is no easy option when it comes to birthing a child. No matter how you give birth, it’s likely to be a draining and tough process, but also one that is life-changing and rewarding. In most cases, vaginal births can be safer than C-sections, but that doesn’t mean that C-sections aren’t safe. C-sections can be a life-saving medical procedure, and without them, there would be preventable maternal and infant mortality and morbidity. However, just as with any surgery, there are risks associated with the procedure, and it is important to discuss these with a trusted healthcare provider.